Interpreter services in emergency medicine

Association between no-show rates and interpreter use in a pediatric otolaryngology clinic

OBJECTIVES

To understand how primary language and interpreter use affect no-show rates in pediatric otolaryngology.

METHODS

This is a retrospective cohort study using medical records of new patients in a pediatric otolaryngology clinic from 2014 to 2019. Data was collected on patient demographics including age, primary language, insurance type, maternal education level, maternal primary language, interpreter use at the first visit, total number of appointments scheduled, number of missed appointments, and number of completed appointments. Inferential statistics using parametric (ANOVA) and non-parametric (Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman correlation coefficient) methods were used.

RESULTS

Primary language was associated with significant differences in no-show rates (p = 0.0474), with Spanish and English speakers having the lowest no-show rate (33%). Overall, interpreter use at the first visit was not significantly associated with subsequent appointment attendance (p = 0.3674). Patients with a documented Spanish interpreter at the first visit had the lowest average no-show rate (31% ± 19%) compared to Haitian Creole (42% ± 18%) and all other languages (32% ± 19%) (p = 0.0265). Hispanic ethnicity, maternal education level, and maternal primary language were not associated with attendance.

CONCLUSION

Interpreter use at the first visit was not significantly correlated with no-show rates, but among patients that did require an interpreter at the first visit, those receiving services in Spanish had the best clinic attendance.

Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome

BACKGROUND

High-quality interpersonal interactions between clinicians and patients can improve communication and reduce health disparities among patients with novice English proficiency (NEP). Yet, little is known about the impact of native language, NEP, and native language concordance on patient on perceptions of interpersonal care in the emergency department (ED).

OBJECTIVE

To determine the associations of native language, NEP, and native language concordance with patient perceptions of interpersonal care among patients undergoing evaluation for suspected acute coronary syndrome (ACS) in the ED.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study included 1000 patients undergoing evaluation for suspected ACS at an urban ED from 2013 to 2016.

MAIN MEASURES

English- and Spanish-speaking patients were surveyed to identify native language, English proficiency (classified as advanced, intermediate, or novice), and perceived language of the treating ED clinician. Patient perceptions of interpersonal care were assessed using the Interpersonal Processes of Care (IPC) survey, a validated 18-item tool for assessing social-psychological domains of patient-clinician interactions. IPC scores ≤ 4 were categorized as sub-optimal (range, 1-5). The associations between native language, English proficiency, and native language concordance with sub-optimal communication were assessed using hierarchical logistic regression adjusted for all three language variables, sociodemographic characteristics, and depression.

KEY RESULTS

Nine hundred thirty-three patients (48.0% native non-English-speaking, 55.7% Hispanic) completed the IPC; 522 (57.4%) perceived native language concordance. In unadjusted analyses, non-English native language (OR 1.38, 95% CI 1.04-1.82) and NEP (OR 1.45, 95% CI 1.06-1.98) were associated with sub-optimal communication, whereas language concordance was protective (OR 0.61, 95% CI 0.46-0.81). In fully adjusted analyses, only language concordance remained significantly associated with sub-optimal communication (AOR 0.62, 95% CI 0.42-0.93).

CONCLUSIONS

This study suggests that perceived native language concordance acts as a protective factor for patient-clinician interpersonal care in the acute setting, regardless of native language or English proficiency.

Importance of medical interpretation in guiding emergent stroke treatment: a case report

ABSTRACTEffective communication between patients and providers is critically important, particularly in the setting of acute illness. In time-sensitive medical emergencies, language barriers may be seen as burdensome, but should be addressed attentively to gather accurate information and to form a trusting relationship with patients and their families. Such is the case with a 79-year-old man who was brought to the emergency department (ED) with symptoms concerning for acute stroke. His Russian-speaking wife was the only source of the patient's history, and information was initially gathered without the aid of a medical interpreter. Based on this information, which was provided in broken English, the patient was determined to be out of the time window to receive intravenous tissue plasminogen activator (IV tPA). Subsequent history taken by the admitting medicine team with the help of a medical interpreter revealed that the patient's symptoms began much more recently than previously understood. Based on the time he was last seen normal, the patient could have been a candidate for IV tPA when he first presented, but the information was clarified after he was outside this time window. Subsequent head imaging confirmed the presence of acute infarct in the left middle cerebral artery territory.This communication failure serves to highlight the importance of thorough and detailed communication between healthcare providers and their patients. As evidenced by the case presented, the outcomes of this underutilization can lead to catastrophic decision-making and, in turn, hinder the ability of providers to provide quality care for their patients.

Moderation of the Association between Primary Language and Health by Race and Gender: An Intersectional Approach

In the United States (US), limited English proficiency is associated with a higher risk of obesity and diabetes. “Intersectionality”, or the interconnected nature of social categorizations, such as race/ethnicity and gender, creates interdependent systems of disadvantage, which impact health and create complex health inequities. How these patterns are associated with language-based health inequities is not well understood. The study objective was to assess the potential for race/ethnicity, gender, and socioeconomic status to jointly moderate the association between primary language (English/Spanish) and having obesity and diabetes. Using the 2018 Behavioral Risk Factor Surveillance System (n = 431,045), weighted generalized linear models with a logistic link were used to estimate the associations between primary language (English/Spanish) and obesity and diabetes status, adjusting for confounders using stratification for the intersections of gender and race/ethnicity (White, Black, Other). Respondents whose primary language was Spanish were 11.6% more likely to have obesity (95% CI 7.4%, 15.9%) and 15.1% more likely to have diabetes (95% CI 10.1%, 20.3%) compared to English speakers. Compared to English speakers, Spanish speakers were more likely to have both obesity (p < 0.001) and diabetes (p < 0.001) among White females. Spanish speakers were also more likely to have obesity among males and females of other races/ethnicities (p < 0.001 for both), and White females (p = 0.042). Among males of other racial/ethnic classifications, Spanish speakers were less likely to have both obesity (p = 0.011) and diabetes (p = 0.005) than English speakers. Health promotion efforts need to recognize these differences and critical systems−change efforts designed to fundamentally transform underlying conditions that lead to health inequities should also consider these critical sociodemographic factors to maximize their effectiveness.

Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care

Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews (n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site (n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.

Access to Translator (AT&T) project: Interpreter on Wheels during the COVID-19 pandemic

We report our experience in using virtual technology in our emergency department (ED) to meet communication needs of our patients who have limited English proficiency (LEP) during the COVID-19 pandemic. Our project aim was to improve communication between our ED staff and patients who have LEP. Specifically, our primary aim was to eliminate the use of healthcare staff as ad hoc interpreters by 50% in our ED by using virtual medical interpreters within 2 months. To achieve our goal, several strategies were employed. First, we assessed the need for interpreters in our ED by tracking the number of times our nursing staff is pulled away from their nursing role to help other staff as an ad hoc interpreter. Second, a patient survey was conducted to understand their thoughts and needs for interpretation in the ED. Third, we developed strategies in improving access to interpreters in our ED. During the COVID-19 pandemic, we conducted a trial of using 'Interpreter on Wheels' (IOW) in our ED. In a 2-month period, we had 477 virtual interpretation encounters totaling 4123 interpretation minutes of IOW usage. We found that it satisfied not only our communication needs but also reduced some of our potential infection control risks during the pandemic.

Patient length of stay, patient readmission rates and the provision of professional interpreting services in healthcare in Australia

Linguistic and ethnic diversity is a feature of patient profiles at almost all public healthcare facilities in urban areas in Australia. Patients with limited proficiency in the socially dominant language - in this case Limited English proficiency (LEP) patients - commonly form a significant patient group in public healthcare settings. Communication barriers that exist between patients and healthcare professionals necessitate the provision of translation and interpreting (T&I) services. This study presents longitudinal data from Melbourne, Australia, on the provision of (T&I) services together with patient length of stay (LOS) and patient readmission rates over a 10-year period at a large, public healthcare provider. Patient LOS and patient readmission rates are key metrics for effective diagnosis and treatment of patients and commonly used to measure the performance of various aspects of healthcare provision. The augmentation of T&I services within a general policy of patient-centred care is shown to accompany decreased LOS and lower readmission rates for LEP patients.

The Use of a Mobile Application to Increase Access to Interpreters for Cancer Patients With Limited English Proficiency: A Pilot Study

BACKGROUND

Language barriers can influence the quality of health care and health outcomes of limited English proficient patients with cancer. The use of medical interpretation services can be a valuable asset for improving communications in emergency care settings.

OBJECTIVE

To evaluate whether a mobile translation application increased call frequency to interpreter services among providers in an Urgent Care Center at a comprehensive cancer center and to assess provider satisfaction of the mobile application.

RESEARCH DESIGN

Prospective pre-post nonrandomized intervention of a mobile translation application with access to an over the phone interpreter (OPI) service at the push of a button and poststudy satisfaction survey.

SUBJECTS

Sixty-five clinicians working at the Urgent Care Center in a cancer center in New York City.

MEASURES

Mean call frequency to OPI services, tested by the nonparametric Wilcoxon Mann Whitney test, and self-reported provider satisfaction descriptives.

RESULTS

The mobile application contributed to increasing the frequency of phone calls to OPI services during the intervention period (mean=12.8; P=0.001) as compared with the preintervention period (mean=4.3), and showed continued use during the postintervention period (mean=5.7). Most clinicians were satisfied with the use of the mobile application and access to the OPI services.

CONCLUSIONS

The results suggest that mobile application tools contribute to increasing the use and ease of access to language services. This has the potential to improve the quality of communication between medical providers and limited English proficient patients in the delivery of cancer care in urgent care settings.

Literature Review: Strategies for Addressing Language Barriers During Humanitarian Relief Operations

Humanitarian relief operations (HUMRO) represent a nexus between military diplomacy and global health engagement, and may play an increasing role in military operations in the near future. Language barriers between providers and the individuals being assisted are a significant constraint on HUMRO. A literature review was conducted to identify recommendations to address patient-provider language discordance in the international HUMRO context. This was supplemented by a North Atlantic Treaty Organization and US Department of Defense doctrinal review to identify existing best practices for addressing language barriers. Four general themes were identified: (1) print-based aids, (2) information technology, (3) bilingual responders, and (4) the effective use of medical interpreters in the HUMRO setting. Each strategy is reviewed. Informed by expert opinion, we provide concrete leadership and training recommendations for how HUMRO providers might more effectively communicate with patients in a deployed language-discordant context.

Minimizing Variability in Interpretation Modality Among Spanish-Speaking Patients With Limited English Proficiency

INTRODUCTION

Provider-patient language discrepancies can lead to misunderstandings about follow-up care instructions and decreased adherence to treatment that may contribute to disparities in health outcomes among patients with limited English proficiency (LEP). This observational study aimed to understand how emergency department (ED) staff went about treating patients with LEP and examine the impact of consistent interpretation modality on overall patient satisfaction and comprehension.

METHOD

A cross-sectional study was conducted among Spanish-speaking patients with LEP presenting to the ED. A survey was administered at two different time points: after patients provided their history of present illness and after the patient received information regarding follow-up treatment.

RESULTS

Analysis of average visual analog scale (VAS) scores by consistency of interpretation suggested higher overall scores among participants that received care via the same communication modalities during both the history of present illness and at disposition, when compared with patients that did not. At both time points, video-based interpretation was associated with higher VAS scores in comparison to other modalities, whereas phone-based interpretation was associated with lower VAS scores.

CONCLUSION

Providing consistent modes of interpretation to patient's with LEP throughout their ED visits improved their overall satisfaction of care provided and understandings of discharge instructions.

Rates and Predictors of Professional Interpreting Provision for Patients With Limited English Proficiency in the Emergency Department and Inpatient Ward

The provision of professional interpreting services in the hospital setting decreases communication errors of clinical significance and improves clinical outcomes. A retrospective audit was conducted at a tertiary referral adult hospital in Brisbane, Australia. Of 20 563 admissions of patients presenting to the hospital emergency department (ED) and admitted to a ward during 2013-2014, 582 (2.8%) were identified as requiring interpreting services. In all, 19.8% of admissions were provided professional interpreting services in the ED, and 26.1% were provided on the ward. Patients were more likely to receive interpreting services in the ED if they were younger, spoke an Asian language, or used sign language. On the wards, using sign language was associated with 3 times odds of being provided an interpreter compared with other languages spoken. Characteristics of patients including their age and type of language spoken influence the clinician's decision to engage a professional interpreter in both the ED and inpatient ward.

Shrinking the language accessibility gap: a mixed methods evaluation of telephone interpretation services in a large, diverse urban health care system

INTRODUCTION

Language interpretation services for patients who are not proficient in a country's official language(s) are essential for improving health equity across diverse populations, and achieving clinical safety and quality for both patients and providers. Nevertheless, overall use of these services remains low, regardless of how they are delivered. In Toronto, Ontario, one of the most ethnically diverse urban centres, the regional local health integration network which oversees the highest concentration of health care organizations servicing 1.2 million residents, partnered with key stakeholders to make Over-the-Phone (OPI) interpretation services broadly and economically available in 170 different languages to its diverse network of health care organizations. This evaluation aimed to assess patients' and providers' experiences with OPI in these varied settings and the impact (if any) on alternative interpretation services and on health service delivery access and quality.

METHODS

This study used a two-phased sequential exploratory mixed-methods approach to evaluate the initiative. Phase I was comprised of semi-structured interviews with representatives from the program stakeholders; these findings were applied to identify appropriate survey questions and response categories, and provided context and depth of understanding to Phase II results. Phase II included web-based and self-administered surveys for both providers and patients engaging with OPI.

RESULTS

Both providers and patients identified a broad range of positive impacts OPI had on health care service delivery quality and access, and high levels of satisfaction with OPI, in a variety of health care settings. Providers also revealed a marked decrease in the use of ad-hoc, nonprofessional strategies for interpretation after the implementation of OPI, and noted it had either no impact on their workload or had decreased it overall.

CONCLUSIONS

OPI is clearly not the sole answer to the complex array of health care needs and access gaps that exist for persons without proficiency in their country's official language. Nevertheless, this evaluation provides compelling evidence that OPI is a valuable component, and that it may contribute to a broader range of positive impacts, and within a broader range of health care settings, than previously explored.

Health and wellness technology use by historically underserved health consumers: systematic review

BACKGROUND

The implementation of health technology is a national priority in the United States and widely discussed in the literature. However, literature about the use of this technology by historically underserved populations is limited. Information on culturally informed health and wellness technology and the use of these technologies to reduce health disparities facing historically underserved populations in the United States is sparse in the literature.

OBJECTIVE

To examine ways in which technology is being used by historically underserved populations to decrease health disparities through facilitating or improving health care access and health and wellness outcomes.

METHODS

We conducted a systematic review in four library databases (PubMed, PsycINFO, Web of Science, and Engineering Village) to investigate the use of technology by historically underserved populations. Search strings consisted of three topics (eg, technology, historically underserved populations, and health).

RESULTS

A total of 424 search phrases applied in the four databases returned 16,108 papers. After review, 125 papers met the selection criteria. Within the selected papers, 30 types of technology, 19 historically underserved groups, and 23 health issues were discussed. Further, almost half of the papers (62 papers) examined the use of technology to create effective and culturally informed interventions or educational tools. Finally, 12 evaluation techniques were used to assess the technology.

CONCLUSIONS

While the reviewed studies show how technology can be used to positively affect the health of historically underserved populations, the technology must be tailored toward the intended population, as personally relevant and contextually situated health technology is more likely than broader technology to create behavior changes. Social media, cell phones, and videotapes are types of technology that should be used more often in the future. Further, culturally informed health information technology should be used more for chronic diseases and disease management, as it is an innovative way to provide holistic care and reminders to otherwise underserved populations. Additionally, design processes should be stated regularly so that best practices can be created. Finally, the evaluation process should be standardized to create a benchmark for culturally informed health information technology.

That I won't translate! Experiences of a family medical interpreter in a multicultural environment

Family members used as patients' interpreters are a common occurrence in the medical environments of multicultural societies. It is recognized that the use of the family-member interpreter may have some benefits. However, studies show that this option also has substantial disadvantages and therefore suggest that the use of professional medical interpreters is the preferable option for effective quality care. The purpose of the current study is to present the narrative of a family-member interpreter in Israel, a diverse immigrant society. While numerous studies have been done on the challenges in the doctor-interpreter-patient medical encounter, these studies tend to focus on the experiences of the physicians or the patients, and the perspective of the interpreter is often sidelined. After discussing the various interpreting options, we suggest that the perspective of the family-member interpreter strengthens assertions that professional interpretation is the best option for multilingual medical environments.